TCM Diagnosis Questionnaire
Horses Name

Age

Mare

Gelding

Owner

E-Mail address


Please describe
your horses problem


Please describe
your horses
Behaviour



Seasons (Mares)
What are they like?



Does your horse
sweat normally?


What colour are his
eye membranes?


What is his skin
condition like?



What are his
urination habits?



What are his
droppings like?


What is his past
medical history?


What colour are his
gums/tongue?





Please list the
drugs/vaccines your
horse has had in the
last 2 years

Observe your horse carefully & fill in all the details.
This will determine the type/types of syndrome that are affecting him & suggest a relevant
course of TCM Herbal Supplementation and/or Laser Therapy.